TABLE OF CONTENTS

EXECUTIVE SUMMARY.............................................................................................................................................1 SECTION 1

STATEMENT OF NEED AND OBJECTIVES.....................................................................................................3

Statement of Purpose .......................................................................................................... 3

Relation to Current HIT Initiatives and the MMIS Environment .............................................. 3

HIT Workgroups and Collaborative Efforts ............................................................................ 5

Opportunities for Efficiency................................................................................................... 6

HIT Environmental Assessment ........................................................................................... 7

SECTION 2

PROJECT MANAGEMENT PLAN ....................................................................................................................... 10

Leadership and Oversight Activities.....................................................................................10

SMHP Development ...........................................................................................................11

Project Organization ...........................................................................................................11

Project Staff ........................................................................................................................12

Key Deliverables .................................................................................................................15

Method for Developing Key Deliverables .............................................................................16

HIPAA Compliance .............................................................................................................18

SECTION 3

PROPOSED PROJECT BUDGET ....................................................................................................................... 19

Cost Elements and Ammounts ............................................................................................19

Cost Allocation Plan ............................................................................................................20

Summary of Costs – FY2010 and FY2011 ...........................................................................22

SECTION 4

CMS REQUIRED ASSURANCES ...................................................................................... 23

1

HEALTH INFORMATION TECHNOLOGY PLANNING ADVANCED

PLANNING DOCUMENT

EXECUTIVE SUMMARY

The Maryland Medical Assistance Program is pleased to submit its Health Information

Technology Planning-Advanced Planning Document (HIT P-APD) to request Federal Financial

Participation (FFP) from the Centers for Medicare and Medicaid Services (CMS) for

administrative costs to support planning activities authorized by the American Reinvestment

and Recovery Act of 2009 (ARRA) Health Information Technology (HIT) Incentive Program.

Title IV of the ARRA established an eleven year program to promote the use of HIT and

electronic health records (EHRs) among Medicaid providers. Under the program, providers

can qualify for 100 percent Federal incentive funding for adoption and meaningful use of

certified EHR technology and support services, such as maintenance and training. Title IV also

authorizes a 90 percent FFP for reasonable administrative expenditures to support state efforts

to administer this program.

The Maryland Medical Assistance Program manages the Maryland Medicaid program. The

objective of Maryland’s HIT P-APD is to describe how the Maryland Medical Assistance

Program will develop a high-level management statement of the state’s vision, needs,

objectives, plans, and estimated costs that will result in a State Medicaid HIT Plan (SHMP), a

deliverable resulting from the HIT P-APD. The SMHP will explain how the Maryland Medical

Assistance Program will administer incentive payments necessary to support the

implementation of certified EHR technology by eligible Medicaid providers, as well as the

procedures to oversee incentive payments made to eligible Medicaid providers.

Included in this HIT P-APD is a description of a series of planning tasks pertaining to: provider

education and awareness activities; development of the SMHP comprised of an “As-Is” HIT

landscape assessment of the current status of HIT, particularly among Medicaid providers; a

“To-Be” vision and Roadmap Plan; development of the HIT Implementation Planning Advance

Planning Document (HIT I-APD) to implement activities identified in the Roadmap Plan

necessary to support the “To-Be” vision and the SMHP; and the development of a Request for

Proposal (RFP) for a vendor to provide operational support and program audit services.

The Maryland Medical Assistance Program will collaborate with the Maryland Health Care

Commission in developing the SMHP. The Maryland Health Care Commission is the agency

identified by the Governor to advance HIT adoption and to implement a statewide health

information exchange (HIE). In November, the Maryland Health Care Commission submitted

the state’s Health Information Technology State Plan (HIT State Plan, see Appendix) to the Office

of the National Coordination for Health Information Technology for funding under the State

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Health Information Exchange Cooperative Agreement Program. Monies received under the

grant will be used to continuously improve and expand HIE services over time to reach all

health care providers in an effort to improve the quality and efficiency of health care. The

SMHP will eventually become part of the HIT State Plan.

Maryland is currently in the implementation phase of an HIE and has a variety of initiatives

that are currently underway to advance EHR adoption in the state. Descriptions of these

projects are provided in Section 2: Overview of Current HIT Initiatives. Pending approval of this

HIT P-APD, the planning project will start on May 1, 2010, for a period of twelve months.

Maryland is requesting a total of $1,370,043 in Federal funds with matching $152,227 of state

funds for a total amount of $1,522,270.

3

SECTION 1

STATEMENT OF NEED AND OBJECTIVES

Statement of Purpose

The purpose of the HIT P-APD is to create the SMHP that will outline the strategic HIT vision

for the Maryland Medical Assistance Program. The SMHP will lay the groundwork for

achieving this vision by describing the current “As-Is” HIT landscape, the desired “To-Be” HIT

landscape, and a comprehensive five year plan for expanding HIT using Medicaid Information

Technology Architecture (MITA) principles and approaches as a foundation . The HIT P-APD

activities also include planning to support the incentive payments for EHR systems authorized

in Section 4201 of the ARRA. Section 4201 of the ARRA provides funding support for certified

EHRs through Medicaid adoption and implementation payments. CMS and the Maryland

Medical Assistance Program will provide oversight, as directed in the ARRA.

The SMHP will become a component of the state’s HIT State Plan and will reflect the high

priority that Maryland places on advancing HIT in the state Medicaid program. Maryland’s

planning efforts have led to a comprehensive design to expand the use of certified EHRs and to

facilitate and expand the secure, electronic movement and use of health information among

providers according to nationally recognized standards. The state has taken an ambitious

approach to advancing HIT that balances the need for information sharing with the need for

strong privacy and security policies, while maintaining a judicious approach to funding the

initial development of a statewide HIE. The SMHP will serve as Maryland’s five year strategic

plan to expand EHR adoption among Medicaid providers and to ensure connectivity with the

statewide HIE in a manner consistent with the existing HIT State Plan. Developing a SMHP that

will become part of the HIT State Plan is an appropriate and timely next step to ensure that the

state has a complete strategic and operational plan for a comprehensive HIT initiative in

Maryland.

Relation to Current HIT Initiatives and the MMIS Environment

Current HIT Initiatives

CMS EHR Demonstration Project

Maryland is one of four states currently participating in the CMS EHR Demonstration Project. A

consortium of stakeholders including the state’s medical society provides guidance to the

initiative. Approximately 127 primary care practices were selected to take part in the

initiative. These primary care practices will receive payment for implementing an EHR d uring

the first year and begin reporting on 26 clinical measures during the remaining years.

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Incentive payments are determined by several factors and the maximum amount for

participation in the five year demonstration project is $290,000 per practice.

Planning for a Statewide Health Information Exchange

Building a successful HIE requires considerable planning in order to implement a business

model that creates incentives for use, and recognizes the need for funding from those

stakeholders who derive value and benefits from using technology that shares health

information. Two distinct groups of diverse stakeholders were brought together to address the

complex policy and technology issues from somewhat different perspectives. The two multi -

stakeholder groups selected to participate in the planning phase were the Chesapeake Regional

Information System for our Patients (CRISP) and the Montgomery County Health Information

Exchange Collaborative. These teams focused specifically on addressing issues related t o

governance; privacy and security; role-based access; user authentication and trust hierarchies;

architecture of the exchange; hardware and software solutions; costs of implementation;

alternative sustainable business models; and strategies to assure appr opriate consumer

engagement, access, and control over the information exchange.

Service Area Health Information Exchange

Providers throughout the state have begun to exchange limited amounts of electronic patient

information. Service area health information exchanges (SAHIEs) are emerging and are

typically made up of providers in a select geographic area that share the same patients across

practices and settings. These providers must address challenges related to privacy and

security, business practices, and technology. A workgroup consisting of chief information

officers, privacy officers, and various other health care stakeholders was convened to develop a

resource guide that includes the policies regarding the patient’s rights to access and control

their health information; the range of business practices for access, authentication,

authorization, and audit; the technical requirements for standards and process workflows; the

communication mechanisms and outreach initiatives; the key community-level financial,

organizational, and policy challenges; and the alternate community data uses.

Initiatives with the Medicaid Management Information System (MMIS)

The Maryland Medical Assistance Program is in the initial stages of releasing a request for

proposal (RFP) to update the existing legacy MMIS to comport with MITA 2.0 principles. Once

complete, the new system should allow for integrated data sharing across agencies, data

monitoring, and workflow management. It will include a robust business rules engine to aide

in creating and managing flexible benefit plans. In the future, MMIS will process all Medicaid

claims and eliminate the duplicative adjudication of the Mental Hygiene Administration (MHA),

Developmental Disabilities Administration (DDA), and dental claims. The MMIS system will

also support coordination of benefits, surveillance and utilization review, federal and

management reporting and case management. These improvements will help the Maryland

Medical Assistance program become more interoperable with the developing EHR network and

HIE.

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HIT Workgroups and Collaborative Efforts

An Assessment of Privacy and Security Policies and Business Practices: Their Impact

on Electronic Health Information Exchange

Various multi-stakeholder workgroups have addressed the issues related to privacy and

security of electronic health information. Approximately eight health care sector groups were

assembled to assess business policies and practices in general, and security policies and

practices in particular that could impede the development of an effective statewide HIE. This

assessment included an examination of each sector group’s perception of HIE; concerns

regarding the benefits, risks, and challenges impacting each group; and various alternatives to

address these issues.

Management Service Organizations

Nearly 30 stakeholders are participating on an Advisory Board to develop criteria for MSOs

that seek state designation. The criteria will include requirements for privacy and security,

technical performance, business practices, and resources. MSOs offer a viable alternative to the

traditional stand-alone EHR client-server model, which requires practices to individually

negotiate pricing and maintain the technology required to support the software. MSOs are

capable of supporting multiple EHR products at reduced costs through economies of scale and

bulk purchasing. Data is safeguarded through a network operating center that, by design,

ensures high quality and uninterrupted service. MSOs enable providers to access a patient’s

record wherever access to the Internet exists. EHRs maintained outside of the physician

practice enables physicians to focus on practicing medicine rather than dedicating staff to

support the application. The state plans on accepting applications from MSOs interested in

becoming state designated in the fall of 2010.

Privacy and Security Solutions and Implementation Activities for a Statewide Health

Information Exchange

A multi-stakeholder workgroup was assembled to formulate solutions and develop

implementation activities that address organization-level business practices affecting

statewide privacy and security policies in order to support interoperable HIE. Workgroup

participants developed guiding principles for exchanging patient informat ion electronically,

and evaluated privacy and security barriers to HIE that impact all stakeholder groups. The

workgroup also evaluated the impact of these barriers on the guiding principles, and proposed

implementation activities to guide the development of HIE in Maryland. Barriers identified by

the workgroup included: access to data, a common patient identifier, concerns regarding the

use of data, funding, interoperability, liability, stakeholder trust, and technical and process

infrastructure. Workgroup participants agreed on a set of guiding principles that included:

accessibility, consumer-centric exchange, emergency access, governance, misuse, security,

standards, and sustainability. These principles and barriers provided the framework for the

solutions developed by the workgroup.

6

Statewide HIE Policy Board

An independent Policy Board that has oversight authority of the statewide HIE was established

by the state. This separation of responsibilities assures a strong role for the public in both

policy development and operational oversight. The Policy Board consists of roughly 25

stakeholders, with the majority of members representing consumers and broad public interest,

as opposed to individuals representing health care interests. The Policy Boar d also includes ex-

officio members from the state, including the Maryland Medical Assistance Program, the

Maryland Health Care Commission, and the Health Services Cost Review Commission. The

statewide HIE is required to implement the Policy Board decision s, which has primary

responsibility for developing policies pertaining to privacy and security, among other things.

Opportunities for Efficiency

Statewide HIE

Implementing a statewide HIE is part of a long-term strategic plan to improve the quality,

safety, and efficiency of care that will create cost savings for the Maryland health care system.

Maryland has many factors working in its favor for implementing a successful and sustainable

statewide HIE. Stakeholder collaboration and broad consensus on key privacy and security

issues has been paramount to the success in planning and implementing a statewide HIE.

Maryland’s relatively compact geography has mitigated some of the distance and

communication challenges that some other state HIE efforts have enc ountered. Maryland’s

unique hospital all-payor rate setting system provides a mechanism for funding this initiative

where all private payers participate equally in the cost of implementing the statewide HIE.

Three years ago, the state began the statewide HIE planning process by engaging numerous

stakeholders to address fundamental policy issues and develop a course of action for

implementing a statewide HIE. These efforts led up to a competitive process where, in August

2009, the state selected CRISP as the state designated HIE entity and authorized nearly $10

million for the initiative through Maryland’s hospital all-payor rate setting system. CRISP

consists of Johns Hopkins Health, MedStar Health, University of Maryland Medical System,

Erickson Retirement Communities, and the Erickson Foundation, along with the support of

more than 25 other organizations.

Centers for Medicare & Medicaid Services EHR Demonstration Project

EHRs are generally viewed as an optimistic advancement in efficiency, productivity, and

workflow. The state expects to increase the use of EHRs through participation in the CMS EHR

Demonstration Project. Maryland is one of four states participating in the CMS five year

demonstration project to encourage small to medium sized primary care physician practices to

use EHRs. Each month, practices that have not adopted an EHR receive educational material.

Practices could be selected to participate in the demonstration without having implemented an

EHR. However, all practices must implement an EHR by 2011 to remain in the demonstration

project. Approximately 254 practices participate in the demonstration project. The

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demonstration project aims to improve the quality and efficiency of patient care by improving

the way health care information is managed.

HIT Environmental Assessment

Assessment of the Current “As-Is” Landscape

The Maryland Medical Assistance Program will use existing data included in the analysis for the

HIT State Plan as the basis for assessing the “As-Is” landscape for Medicaid providers. The

Medicaid Information Technology Architecture State Self-Assessment (MITA S-SA) will also

provide critical information in determining the “As-Is” landscape of the Medicaid systems and

HIT adoption and readiness of Medicaid providers. Objectives associated with this assessment

include: determining the field of eligible providers, identifying barriers to acceptance of HIT by

providers, identifying barriers to acceptance of HIT by Medicaid beneficiaries, providing a

foundation for identifying future goals and available resources by assessing the status of the

current program and HIT environment; determining the interrelationships between Medicaid,

Medicare and other populations as they relate to the adoption of HIT; and identification of

policy issues where additional guidance from CMS may be required.

Nearly five years ago, the Maryland Board of Physicians that licenses physicians began

collecting practice information from physicians, which includes an assessment of HIT adoption.

Physicians are required to renew their license every two years. Practice information is

compiled into a data base that will be used in assessing the current state of HIT adoption

among Medicaid providers. Ad hoc workgroups are also expected to provide information that

can be used to augment the data with questions that were not included in the Maryland Board

of Physicians’ practice questions. The data will be evaluated by jurisdiction and ranked by the

level of adoption. This information will be used in developing a strategy to advance HIT

adoption by Medicaid providers.

For the most part, EHR adoption in Maryland is consistent with national statistics. The

Maryland Medical Assistance Program expects to collaborate with bordering state Medicaid

agencies to share its findings of the “As-Is” landscape and to identify synergies that can be used

in developing the “To-Be” vision in the SMHP. The existing HIT State Plan indicates that EHR

adoption is at about 34 percent for physicians in Maryland with the lowest cou nty reporting

adoption of just about 24 percent. Approximately 13,795 physicians are in active practice in

Maryland. Roughly 5,035 are in primary care practices and nearly 3,666 are priority primary

care providers, providing care in about 2,325 practices. Physicians that have fully deployed

EHRs account for around four percent. The adoption rates for practices with fewer than 10

providers (88 percent of all practices in the state) are dramatically lower, as seen in the table

below.

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Practice EHR Adoption Rates

Practice Size

Percent Adoption

Percent of Practices

1 13 35

2-4 16 40

5-9 20 13

10-19 29 7

20+ 39 5

Maryland covers 9,774 square miles, with a 2008 population of about 5,633,597 with almost

302,052 individuals who live in rural parts of the state. According to the U.S. Census Bureau,

more than 40 percent of the state’s 5.6 million people are Hispanic, African-American, or Asian

– making it one of the more diverse states in the nation. Approximately 13.8 percent of the

state’s population is uninsured, or about 769,007 individuals. Roughly 88 Federally Qualified

Health Centers (FQHCs) serve patients in the state of Maryland. The majority of FQHCs are

clustered in urban areas with a small portion located in rural parts of the state.

Completion of the “To-Be” Vision and Roadmap Plan

The Maryland Medical Assistance Program expects to develop a “To-Be” vision using HIT to

improve health care quality and patient safety, promote care coordination and continuity, and

assist in clinical decision making and the use of evidence-based guidelines. Consumer control

over their health information and the development of sound policy related to access,

authorization, authentication, and audit are essential components of the vision. The Maryland

Medical Assistance Program will develop a Roadmap Plan with milestones and objectives that

meets the meaningful use criteria in the proposed Medicare and Medicaid Programs; Electronic

Health Record Incentive Program; Proposed Rule. The Roadmap Plan will include overseeing

the Medicaid incentive payment to eligible providers and readying nearly 5,901 Medicaid

physicians to participate in the ARRA EHR incentives.

The SMHP will consist of a five year strategy to implement a Roadmap Plan that will address

the administration of provider incentive payments, including provider eligibility

determination, issuance and tracking of incentive payments, and auditing of financials and

meaningful use. Objectives associated with these activities include: identification of short-

term and long-term goals for the project; development of recommendations to ensure cost -

effective strategies to be realized as part of the “To-Be” vision; establishment of measurable

benchmarks, milestones, tasks, and timelines to guide project progress; and establishment of

the framework for the development of I-APD tasks and activities. The Maryland Medical

Assistance Program will bring together various stakeholder workgroups to address particular

components of the Roadmap Plan and to identify appropriate measurable benchmarks.

The five year strategy will be aligned with the MITA transition. The “To-Be” vision and

Roadmap Plan will provide direction in the development of the transition plan with the MITA

requirements. The Maryland Medical Assistance Program assessed the current Medicaid

9

Management Information System (MMIS) along with the current Medicaid pr ocesses. This

information will be used to develop a transition plan as part of the SMHP to align with the

federally mandated MITA requirements. The MITA initiative is expected to modernize existing

system functions and significantly enhance the goals of the MMIS. Replacing the existing legacy

MMIS claims processing system with a new MMIS system based on the MITA requirements is

part of the “To-Be” vision and Roadmap Plan.

HIT Implementation Advanced Planning Document

The Maryland Medical Assistance Program will develop a HIT Implementation Advanced

Planning Document (HIT I-APD) with the guidance of CMS, establishing specific

implementation activities necessary to support the SMHP. Stakeholder involvement is a critical

component in developing the HIT I-APD. The Maryland Medical Assistance Program plans to

assemble stakeholder workgroups to fully address the objectives associated with this activity,

and to develop a detailed approach to the implementation of the plan and obtain supporting

FFP. The HIT I-APD development will be an iterative process; development of the document is

expected to occur throughout the planning phase of the project.

Information contained in the SMHP will serve as the framework for the HIT I -APD. Developing

the SMHP requires considerable planning in order to ensure that the vision and Roadmap Plan

can be achieved. These efforts are very similar to the work that was required to develop the

HIT State Plan. In general, the HIT State Plan is a reflection of a strategic and operational plan

that emerged from several years of planning across all stakeholder groups. The SMHP will

include a strategy for administering the ARRA incentives that will help providers derive value

and benefits for using HIT to store and share electronic health information. Issues related to

privacy and security; role-based access; user authentication and trust hierarchies; and

hardware and software solutions, among other things will be addressed in the SMHP.

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SECTION 2

PROJECT MANAGEMENT PLAN

Leadership and Oversight Activities The executive sponsor for developing the HIT P-APD and completing the work that will lead to

the development of the SMHP is Charles Lehman, Executive Director , Office of Systems,

Operations & Pharmacy at the Maryland Medical Assistance Program. Mr. Lehman can be

contact by telephone at (410) 767-5420 or via e-mail at CLehman@dhmh.state.md.us. Project

oversight will be the responsibility of Mr. Lehman. Mr. Lehman will work closely with the state

designated HIT Coordinator, David Sharp, Director of the Center for Health Information

Technology at the Maryland Health Care Commission to ensure that EHR adoption achieves

interoperability with the HIE.

The Maryland Medical Assistance Program will manage the project, identify policy issues

across all impacted departments and state agencies and will coordinate communications with

stakeholders. In order to develop the “To-Be” vision, the Maryland Medical Assistance Program

will work with a contractor to initiate discussions with key stakeholders about the future of

HIT in Medicaid that will be defined in the SMHP. Leading stakeholders included in the

discussion will be:

Providers;

Hospitals;

County Health Departments;

Community Health Centers;

Managed Care Organizations; and

State Agencies involved with Public Health, Behavioral Health, Education, Long -Term

Care, and Rehabilitation.

The SMHP will also include the specific actions necessary to implement the EHR incentive

program. The SMHP will describe a roadmap of steps needed to move from the current state of

HIT to the HIT landscape desired in 2014 to achieve CMS’s Stage 3 for meaningful use.

The Maryland Medical Assistance Program will use a competitive process following existing

state procurement regulations to identify a contractor that can assist in the work.

Specifications for the contractor will be published on eMaryland Market Place; responses will

be evaluated by a panel assembled by Maryland Medical Assistance Program.

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SMHP Development

The Maryland Medical Assistance Program will work closely with the Maryland Health Care

Commission to provide guidance in assessing the “As-Is” landscape, completing the “To-Be”

vision, and the Roadmap Plan of the SMHP. The project will include approximately 28 staff

resources internal to the state from the Maryland Medical Assistance Program and, if

necessary, the Maryland Health Care Commission. These individuals will dedicate a portion of

their time to complete the work leading to development of a SMHP.

Project staff will consist of a Project Director, Special Assistant to the Project Director and

Liaison to Team Project Managers, three Health Policy Analysts, as well as five project

managers and their teams to oversee various pieces of EHR planning activities. A contractor

will be engaged to complete select activities of the project. The Project Director will develop

the scope of work for the contractor with well-defined milestones and deliverables, and the

Special Assistant and Project Director will work together to manage the contractor’s work.

Project staff will establish workgroups and engage appropriate stakeholders to provide input

into the development of the SMHP. These individuals will be a critical component in

developing solutions to strategic issues affecting the planning of the SMHP.

Project Organization

The Maryland Medical Assistance Program has developed a conceptual organizational

structure for the project. The staffing matrix will facilitate the work leading to the

development of the SMHP.

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Project Staff Completing the project requires a combination of resources at the Maryland Medical Assistance

Program and the Maryland Health Care Commission. Project participants are expected to

allocate sufficient time to the work at various stages based on project milestones. The

contractor will perform activities identified during the development of the procurement

specifications. Project staff identified for the project will have prior HIT and policy expe rience.

The Project Director will have responsibility for ensuring the completion of the work. The

Maryland Medical Assistance Program believes that assigning staff from various departments

to specific “teams” will provide the expertise necessary to comp lete the work leading up to the

development of the SMHP. The anticipated costs and leading staff activities are described

below; the project is expected to take approximately twelve months to complete.

Office of Medical Assistance Deputy Secr etary

Maryland Medicaid HIT Project Director Chuck Lehman

Maryland Government HIT Coordinator – MHCC

Systems Team Project

Manager

Quality and Analysis Team

Project Manager

Provider Outreach

Team Project Manager

Outreach and Policy Team

Project Manager

Finance and Procurement Team Project

Manager

Special Asst. to Project Director

& Liaison to Project Managers

HPA

HPA

HPA

Project Support

Contractor

SMHP V endor

Environmental Scan Vendor

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Proposed Staffing Model

Planning Phase Percent FTEs #FTE

Project Director 20% 1

Special Asst to Director, Liaison to Project Managers 75% 1

Health Policy Analyst 50% 1

Health Policy Analyst 30% 2

System Team Project Manager 20% 1

System Team Staff 10% 3

Quality and Analysis Team Project Manager 10% 1

Quality and Analysis Team Staff 10% 3

Provider Outreach Team Project Manager 10% 1

Provider Outreach Team Staff 10% 8

Outreach and Policy Team Project Manager 10% 1

Outreach and Policy Team Staff 10% 2

Finance and Procurement Team Project Manager 10% 1

Finance and Procurement Team Staff 10% 2

Contractor (selected via competitive bid) TBD TBD

Total (less contractor) 28

Project Director

The Project Director will have responsibility for ensuring the planning and development of the

SMHP and eventually the I-APD. This individual will select project participants and work

closely with these individuals throughout the project. The Project Director will collaborate

with the Maryland Health Care Commission and the executive sponsor for the project. This

individual will oversee the various activities for developing the SMHP. The Project Director has

responsibility for ensuring that all phases of work are completed timely and in accordance with

the established plan. The Project Director will also track the number of staff hours on the

project using a Project Tracking System developed in Excel. The Project Tracking System will be

used to monitor staff time dedicated to the project and ensure the integrity of the charges for

monthly billing. This position reports to the Deputy Secretary, Health Care Financing.

Special Assistant to Director and Liaison to Project Managers The Special Assistant to the Director should be a 0.75 to full -time FTE position because this

individual will manage the day to day activities of the project plan with vendors, MHCC and

Medicaid Teams. This individual will develop work plans to ensure that all projects have

clearly defined goals, objectives, and performance timeframes. The Special Assistant will work

14

with the Director and MHCC to provide guidance to the contractor and maintain appropriate

levels of communication with all stakeholders and workgroups. Facilitating workgroups will

be an important part of this individual’s responsibility. The Project Manager will be e xpected

to provide routine guidance to the Health Policy Analysts. This individual will also have

responsibility for ensuring that all work is completed on schedule with the highest possible

quality. This position reports to the Project Director.

Health Policy Analysts

The three Health Policy Analysts will be responsible for staffing workgroups and preparing

meeting materials. These individuals are responsible for completing the research necessary to

provide workgroup participants with a framework of the issues to be addressed by the

workgroup. The Health Policy Analysts will be responsible for compiling workgroup

recommendations and documenting their key concerns. These individual are responsible for

supporting the drafting of the SMHP. The Health Policy Analysts will provide support to the

Special Assistant and the Director in developing work plans, conducting literature reviews,

developing presentations, writing information briefs, performing data analysis, making policy

recommendations, and providing guidance as directed by the Special Assistant to the

contractor. This position reports to the Special Assistant.

Systems Team

The Systems Team will work closely with the Maryland Health Care Commission to develop the

Maryland Medical Assistance Program HIT “As-Is” and “To-Be” assessments, developing the

systems implementation plans, and preparing the SMHP and the Implementation APD.

Through this process, the team will identify the changes that are required to the MMIS and

other State systems in order to implement the infrastructure to support the information

exchange between providers, Medicaid, and CMS and to help facilitate “meaningful use” of

EHRs. The Systems Team will also be responsible for defining the system requirements for

making the provider incentive payments.

Quality and Analysis Team

The Quality and Analysis Team will be responsible for developing the tools needed for

measuring and monitoring quality. This team will work with the Systems Team in defining the

requirements to become an eligible provider and monitoring approaches to maintain the

accuracy and quality of EHR data and EHR’s effect on health care quality outcomes.

Provider Outreach Team

This team will be responsible for all of the provider planning, outreach, training and

coordination of technical assistance. The team will coordinate with the Quality and Analysis

Team to work with the Environmental Scan vendor. They will also work with the Director and

Special Assistant on various stakeholder workgroups through the planning pha se.

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Outreach and Policy Team

This team will be responsible for developing policy and reaching out to stakeholders other than

providers. This team will also oversee regulatory and statutory review efforts during the

planning phase. They will also monitor the effect of EHRs on health care quality and make

suggestions for encouraging quality improvement in consultation with Quality and Analysis

Team.

Finance and Procurement Team

This team will be responsible for work related to procurement of vendors, as we ll as

establishing payment methods for eligible providers.

Contractor

The work of the HIT P-APD will be supported by a contractor procured through Maryland’s

competitive bid process. With the assistance of the Special Assistant, the Project Director wil l

develop a statement of work that reflects the key deliverables, as outlined below. Once the

statement of work has been developed, it will be submitted to CMS for review and approval.

Upon the approval from CMS, the Maryland Medical Assistance Program will notify the industry

that it is accepting bids for a contractor to assist in the work effort. The Project Director and

Special Assistant to the Director will monitor the activities of the contractor to ensure that the

work is consistent with the established goals and objectives.

Vendor Support

The Maryland Medical Assistance Program will procure assistance from two vendors to

complete the required activities. The vendors will be tasked with completing the

environmental scan and developing the SMHP. These vendors will be identified through a

bidding process that is consistent with Maryland’s procurement regulations. The Project

Director will be responsible for ensuring that the vendors meet the deliverables of the contract.

The Special Assistant will provide routine guidance to the vendors as they complete their work.

Key Deliverables

The Maryland Medical Assistance Program will maintain and utilize a project plan to track the

project’s schedule. This schedule will itemize all of the key deliverables as part of the planning

phase. A proposed, preliminary, and high-level project planning phase schedule that lists the

leading deliverables and based upon a May 3rd funding award is list below.

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Leading Activities

Planning Phase Task Start Date Finish Date

Submit HIT P-APD to CMS/CMS Approval 12/01/2009 03/31/2010

Determine Statement of Work (SOW) 03/31/2010 04/16/2010

Submit SOW to CMS for Review and Approval 04/30/2010 05/07/2010

Conduct Provider Outreach and data gathering for “As-Is”

Assessment 05/10/2010 03/31/2011

Complete “As-Is” Landscape Asse ssment Component 06/23/2010 09/24/2010

Complete “To-Be “Vision Component 07/22/2010 10/22/2010

Complete Roadmap Plan Component 08/16/2010 12/31/2010

Finalize the SMHP 06/30/2010 03/31/2011

Submit SMHP to CMS 06/31/2010 06/31/2010

Prepare I-APD 01/10/2011 02/16/2011

Submit Implementation I-APD to CMS 03/01/2011 03/01/2011

Complete RFP Development and Contractor Procurement for Support

Services 05/03/2011 05/24/2011

Commence Operational Activities, Including Support, Program

Audit/QA Services , and Incentive Payment Structure and System 02/01/2011 Ongoing

Method for Developing Key Deliverables

“As-Is” HIT environmental evaluation

Develop an assessment of the Maryland Medical Assistance Program providers’ current HIT

landscape, which will detail the “As-Is” environment.

Conduct a feas ibility assessment of the Maryland Medical Assistance Program

alignment with existing and external HIT/HIE efforts;

Identify MMIS capabilities, or current functionality to participate in HIE; and,

Conduct an environmental scan of existing systems, which may need updating or

replacing in order to meet the standards required to support HIT that include the

follow ing:

o Examine the current rate of EHR adoption and the barriers to meaningful use among

providers in the Maryland Medical Assistance Program; and,

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o Conduct an assessment of the Maryland Medical Assistance Program readiness of

the larger public providers of Medicaid primary care services, the county h ealth

departments, etc.

Identify specific actions necessary to implement the ARRA provider incentive program.

Develop a methodology, solution and budget for the identif ication of eligible providers,

payment mechanism, auditing and tracking payments, and monitoring compliance with

meaningful use that will include:

o An algorithm for identifying volume threshold being met;

o Coordination with CMS on payments to hospitals and providers; and

o Establishing standards for data being reported to ensure quality and consistency.

Develop the SMHP and “To-Be” HIT Landscape

Develop Maryland Medical Assistance Program specific measures of meaningful use in

coordination with the Regional Extension Center.

Develop an information toolkit for small providers to use in complying w ith the proposed

meaningful use criter ia that also includes printed materials for patients as a follow up to

the vis it or for post procedure care.

Explore other potential uses of the EHR such as:

o Reporting on measures of meaningful use process and quality measures for the

Medicaid incentive program.

Evaluate the Maryland Health Care Commission Physic ian EHR Product Portfolio that

inc ludes :

o Identifying enhancements to the information contained on the website, and;

o Propose additional features that will bolster its use by small practices in the state.

Develop an outreach plan and budget for providers to be included in guidance and

training.

o Develop training seminars, focus groups and workshops for providers;

o Develop an outreach plan for media buys, verbiage, and timeline and schedule for

disseminating all information;

o Establish a dedicated mailbox for responding to provider inquir ies as well as a toll free

number for those without e-mail access, such as providers in rural areas; and,

Identify budget and needs assessment for dedicated staff and hardware/telecommunication

for call centers in responding to provider inquir ies.

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Develop a preliminary Roadmap Plan, Issues and Challenges Report to move to the “To-Be” HIT

landscape desired in 2014.

Work with the Maryland Health Care Commission to identify key issues and challenges to

inc lude in the report.

o Meet with various stakeholders to discuss leading issues and challenges to be inc luded

in the report;

o Assemble a stakeholder workgroup to propose solutions to the lead ing issues and

challenges;

o Develop a report that identif ies the issues, challenges, and proposed solutions; and

o Draft the SMHP that can be used to plan the implementation activities that will be

detailed in the HIT I-APD.

HIPAA Compliance The Maryland Medical Assistance Program requires its systems to be fully compliant with the

Health Insurance Portability and Accountability Act of 1996 (HIPAA) Administrative

Simplification Provisions. All aspects of the work will be evaluated for compliance with the

HIPAA requirements. The contractor on this project will be required to sign a Business

Associate Agreement.

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SECTION 3

PROPOSED PROJECT BUDGET

Cost Elements and Amounts

Included below are the summary level budget estimates for planning phases. This section also

contains the non-matching FFP amount that will be accounted for by the Maryland Medical

Assistance Program to manage the project. This budget was prepared using actual and

estimated costs from similar projects. The project is expected to take approximately twelve

months to complete.

Staffing Costs

Planning Phase Percent

FTEs Cost

Project Director 20% $24,800

Special Asst to Director, Liaison to Project

Managers 75% $63,000

Health Policy Analyst 50% $34,680

Health Policy Analyst 30% $38,810

System Team Project Manager 10% $23,500

System Team Staff 10% $30,500

Quality and Analysis Team Project Manager 10% $10,680

Quality and Analysis Team Staff 10% $29,460

Provider Outreach Team Project Manager 10% $12,400

Provider Outreach Team Staff 10% $81,170

Outreach and Policy Team Project Manager 10% $12,400

Outreach and Policy Team Staff 10% $20,440

Finance and Procurement Team Project Manager 10% $10,500

Finance and Procurement Team Staff 10% $16,930

Subtotal Medicaid Staffing Cost $409,270

Contractor (selected via competitive bid) TBD $80,000

Total $489,270

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The Maryland Medical Assistance Program assumptions for this budget include the following:

State project staff – The cost of $409,270 is based on staffing for approximately twelve

months. The rate for staff time is based on an average cost of salary and benefits for the

position.

Contractor – Based upon recent state procurements dealing w ith similar activities, the

Maryland Medical Ass istance Program estimates that the contractor will cost

approximately $80,000 for planning activities.

Non-Personnel Expenses

Category Total Percent State Percent Federal

Vendor Services – Outreach Activities $250,000 10% $25,000 90% $225,000

Vendor Services – Environmental Scan $275,000 10% $27,500 90% $247,500

Vendor Services – SMHP Development $400,000 10% $40,000 90% $360,000

Auditing $50,000 10% $5,000 90% $45,000

Travel $8,000 10% $800 90% $7,200

Provider Communication Materials and Supplies $50,000 10% $5,000 90% $45,000

Total $1,033,000 10% $103,300 90% $929,700

The Maryland Medical Assistance Program assumptions for this budget include the following:

Non-personnel services costs – The cost is $1,033,000 and includes vendor support in

conducting the environmental scan, developing the SMHP, and performing outreach

activities. Also inc luded in the non-personnel services are costs for auditing, travel, and

extens ive provider communication materials and supplies.

Cost Allocation Plan The following charts show the cost totals for various categories, as well as the state share

versus federal share. Total costs for the HIT Planning Project is $1,522,270. The federal share

at 90 percent is $1,370,043. The state share, which will come from special funds, is $152,227.

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Anticipated Costs and Distribution

Summary of Costs – State of Maryland and Contractor

Planning Phase Total Percent State Percent Federal

Project Staff $409,270 10% $40,927 90% $368,343

Contractor $80,000 10% $8,000 90% $72,000

Non-personnel Services $1,033,000 10% $103,300 90% $929,700

Total $1,522,270 10% 152,227 90% $1,370,043

All HIT project planning costs will initially be allocated 100 percent to the Maryland Medical

Assistance Program. While it currently appears that these costs will depend 100 percent on

Medicaid, the Department acknowledges that additional programs may be impacted and this

may later result in the need to develop a new cost allocation plan in accordance with OMB

Circular A-87 principles.

The Chart on the next page shows the HIT Planning Project budget by federal fiscal quarter.

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HIT PROJECT COST SUMMARY BY FEDERAL FISCAL QUARTER

Summary of Costs – FY2010: Fiscal Quarter and Fiscal Year

FY2010 QTR 3 FY2010 QTR 4 FY2010 Summary

FFP Federal Share State Share Federal Share State Share Federal Share State Share

State Resources 90% 92,085.75 10,231.75 92,085.75 10,231.75 184,171.50 20,463.50

Project Contractor 90% $18,000 $2,000 $18,000 $2,000 36,000 4,000

Vendor Services 90% $208,125 $23,125 $208,125 $23,125 416,250 46,250

Travel 90% $1,800 $200 $1,800 $200 3,600 400

Supplies 90% 11,250 1,250 11,250 1,250 22,500 2,500

Auditing 90% 0 0 0 0 0 0

FY2010 Total 90% 331,260.75 36,806.75 331,260.75 36,806.75 662,521.50 73,613.50

Summary of Costs – FY2010: Fiscal Quarter and Fiscal Year

FY2011 QTR 1 FY2011 QTR 2 FY2011 Summary

FFP Federal Share State Share Federal Share State Share Federal Share State Share

State Resources 90% 92,085.75 10,231.75 92,085.75 10,231.75 184,171.50 20,463.50

Project Contractor 90% $18,000 $2,000 $18,000 $2,000 36,000.00 4,000.00

Vendor Services 90% $208,125 $23,125 $208,125 $23,125 416,250.00 46,250.00

Travel 90% $1,800 $200 $1,800 $200 3,600.00 400.00

Supplies 90% 11,250.00 1,250.00 11,250.00 1,250.00 22,500.00 2,500.00

Auditing 90% $22,500 $2,500 $22,500 $2,500 45,000.00 5,000.00

FY2011 Total 90% 353,760.75 39,306.75 353,760.75 39,306.75 707,521.50 78,613.50

Summary of Costs – FY2010 and FY2011

Total Federal Share State Share

FY2010 Total $736,135 $662,521.50 $73,613.50

FY2011 Total $786,135 $707,521.50 $78,613.50

HIT PROJECT TOTAL $1,522,270 $1,370,043 $152,227

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SECTION 4

CMS REQUIRED ASSURANCES

The State of Maryland provides CMS the following assurances in accordance with the

requirements of 45 CFR 95.613, and 95.615, and 42 CFR 433.112(b)(5)-(9).

Requirements

Category 45 CFR Section Yes No

Procurement Standards (Completion/Sole Source) 45 CFR 95.613 X

Access to Records 45 CFR 95.617 X

Software and Ownership Rights 42 CFR Part 433.112(b)(5)-9 X

Federal Licenses 42 Part CFR 433.112(b)(5)-(9) X

Information Safeguarding 42 CFR Section 431.300 X

HIPAA Compliance 45 CFR Part 164 X

Progress Reports X

Basis for Request of Enhanced FFP

In order to provide the proper and efficient administration of the plan, as described in 42 U.S.C

1396.b. (a) (D), the Maryland Medical Assistance Program requests enhanced FFP for planning

activities to support the Medicaid HIT project. Maryland will provide the requisite matching

state funds for the cost of the project.